The document discusses the components of conducting a scene size-up and initial patient assessment, including scene safety, mechanism of injury, primary and secondary surveys, identifying priority patients, taking vital signs, and obtaining a SAMPLE history. Key steps include assessing the scene for safety, airway, breathing, circulation, mental status, and gathering patient information using the SAMPLE format of Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading to the current situation.

1. Seven Chapter Scene Size-Up, Initial Assessment, Baseline Vitals, and SAMPLE History

2. Components of the scene size-up and how they relate to your personal safety as well as to other parts of the call Initial assessment, including identification and correction of life threats and priority determination SAMPLE history and vital signs Seven Chapter CORE CONCEPTS

3. O VERALL ASSESSMENT SCHEME Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP

4. Scene Size-up An assessment to ensure the well-being of the EMT-Basic K EY TERM

5. Scene Safety Protect bystanders (prevent them from becoming patients) . Never enter an unsafe scene. Make scene safe or call for someone who can. (Continued)

6. S CENE SAFETY TECHNIQUES

7. Scene Safety Techniques: Observation Fighting or loud voices Intoxicants or illegal drugs Weapons Crime scenes Pets

8. Crash or Rescue Scenes Toxic Substances or Hazmat

9. Crime Scenes & Violence Unstable Surfaces: Slopes, Ice, Water

10. Scene Safety Techniques: Responses to Danger Use cover and concealment. Retreat. Use distractions if necessary. Carry a portable radio.

11. Scene Safety Techniques: Planning for Safety Work together. Make your equipment work for you. Dress for safety. Use body armor, if necessary.

12. Body Substance Isolation Anticipate the need for BSI. Always have BSI equipment available. Use appropriate equipment to prevent exposure. (Continued)

13. BSI Review: Gloves Mask and Eye Protection (Continued)

14. BSI Review: Gown

15. Mechanism of Injury The physical event that caused an injury (fall, motor vehicle accident, etc.) K EY TERM

16. Mechanism of Injury: Trauma Determined from Patient Family Bystander Observation of the scene

17. Distance patient fell Part of patient’s body that struck surface Type of surface landed on Did anything break the fall? Mechanism of Injury: Falls

18. Mechanism of Injury: Motor Vehicle Collision - Head On (Continued)

19. Mechanism of Injury: Motor Vehicle Collision - Rear Impact (Continued)

20. Mechanism of Injury: Motor Vehicle Collision - Side Impact (Continued)

21. Mechanism of Injury: Motor Vehicle Collision - Rollover (Continued)

22. Mechanism of Injury: Motor Vehicle Collision Rotational Multiple injury patterns. (Continued)

23. Mechanism of Injury: Motor Vehicle Collision Ejection Deformed windshield, steering wheel, etc. Amount of vehicle deformity Seat belt use

24. Mechanism of Injury: Vehicle Interior

25. Velocity Body region penetrated Exit wounds (Continued) Mechanism of Injury: Penetrating Trauma

26. Mechanism of Injury: Penetrating Trauma

27. Nature of Illness: Medical Patient Sources of Information Scene Patient Family and bystanders

28. Adequacy of Resources Number of patients? Hazardous materials? Fire or rescue? Unusual situations? (Continued)

29. Call for assistance before beginning care. Use triage procedures if necessary. Adequacy of Resources

30. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME

31. Form a General Impression Environment Age Sex Apparent threats to life

32. Assess Mental Status A lert V erbal stimulus P ainful stimulus U nresponsive

33. P RECEPTOR P EARL Many EMT-Bs, especially at the beginning of their careers, are reluctant to apply a painful stimulus. Out of shyness or a reluctance to harm the patient, they apply only a mild stimulus that is not sufficient to rouse the patient. The EMT then notifies the ED that the patient is unresponsive to verbal and painful stimuli. But on arrival at the ED, the staff is easily able to elicit a response with a brisk sternal rub or a pinch of the trapezius. Watch for this tendency with new or inexperienced EMT-Bs, and give them the benefit of your experience.

34. Assess the airway.

35. Open and Maintain Airway Medical Patients: Use head tilt, chin lift. Suction and insert oral or nasal airway as necessary. (Continued)

36. Trauma Patients: Immobilize the head manually. Use jaw thrust as necessary. Suction and insert oral or nasal airway. Open and Maintain Airway

37. Assess breathing.

38. Breathing If breathing is inadequate, ventilate with 100% oxygen. If respirations are adequate but faster than 24/minute, give high-concentration oxygen.

39. P RECEPTOR P EARL New EMT-Bs, in their desire to explain to the patient everything that is going on, may say something like, “I’m going to count your breaths right now, so just relax.” Of course, the patient who knows someone is counting his or her breathing rate will think about it and probably breathe either faster or slower as a result. If you hear new EMT-Bs using this approach, remind them that counting a respiratory rate should be done without bringing the patient’s attention to it.

40. Circulation: Pulse, bleeding, skin

41. In adults and children, check radial pulse first. If no radial pulse, check carotid pulse. Pulse If no carotid pulse, start CPR and use AED as appropriate.

42. Infants: Check brachial pulse.

43. Look for and control severe bleeding.

44. Skin Color Temperature Condition

45. Infants/children: Capillary refill

46. Identify Priority Patients Poor general impression Unresponsive Responsive but not following (Continued) commands Difficulty breathing Shock (hypoperfusion)

47. Uncontrolled bleeding Severe pain anywhere Complicated childbirth Identify Priority Patients Chest pain with systolic blood pressure < 100

48. Focused history and physical exam (medical) or Focused history and physical exam (trauma) Determine Next Assessment Step

49. Scene Size-Up Initial Assessment Trauma Medical Physical Exam Vital Signs & SAMPLE History SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam Ongoing Assessment HOSP O VERALL ASSESSMENT SCHEME

50. Baseline Vital Signs Respirations Pulse Skin Pupils Blood pressure

51. Respirations

52. Normal Shallow Labored Noisy Quality of Breathing

53. Pulse Strong or weak Regular or irregular

54. If you cannot feel a radial pulse, check the carotid pulse.

55. Check skin color, temperature, and condition.

56. Pale Cyanotic Flushed Jaundiced Abnormal Skin Colors

57. Abnormal Skin Temperatures Hot Cool Cold

58. Abnormal Skin Conditions Wet Very dry

59. Pupils

60. Abnormal Pupil Conditions

61. Palpation Auscultation Measuring Blood Pressure

62. Pulse Oximetry Measures oxygen circulating in the blood 95 – 99% considered normal

63. Pulse Oximetry Precautions Not accurate in shock or hypothermia False readings in carbon monoxide poisoning Movement and nail polish can cause inaccurate readings NOTE: Do not withhold oxygen from a patient who may need it because the oximeter reads “normal.”

64. Reassessment of Vital Signs Stable patient: every 15 minutes Unstable patient: every 5 minutes

65. Sample History S igns and symptoms A llergies M edications P ast medical history L ast oral intake E vents leading to the injury or illness

66. Pertinent past history should include medical, surgical, and trauma factors.

67. 1. What are the components of a scene size-up? 2. List the steps in the initial assessment of a patient. 3. Give examples of patients who should be handled as a “high priority.” 4. What does the acronym SAMPLE stand for? 5. What is the range of normal vital signs? R EVIEW QUESTIONS